Registered Nurse – Clinical Reviewer – Utilization Review

Pay: $45.00 - $50.00 per hour

Job description:

RN Clinical Reviewer Responsibilities

The Registered Nurse Clinical Reviewer will be responsible for completing clinical-level reviews and supporting the overall medical review process.

Responsibilities include:

• Complete utilization review and quality review activities as assigned
• Review clinical documentation, medical records, and chart information for accuracy and completeness
• Apply nursing knowledge to evaluate clinical information according to review program requirements
• Support Medical Review Analysts and Physician Consultants throughout the review process
• Identify clinical trends, documentation concerns, or issues requiring additional review
• Communicate findings clearly and professionally
• Work collaboratively with clinical, medical, analytical, and administrative support teams
• Assist with problem-solving related to clinical review workflows
• Maintain accurate documentation of review activities
• Follow established policies, procedures, and program guidelines
• Use electronic medical record systems and clinical documentation platforms as needed

Requirements

Qualified candidates should have:

• Active New York State Registered Professional Nurse license
• Bachelor’s degree in Nursing or graduation from an approved Registered Professional Nurse training program
• Minimum of 2 years of experience in an acute care facility
• Medical/surgical, special care unit, or similar acute care experience preferred
• 1–3 years of acute care utilization review experience preferred
• Knowledge of electronic medical records
• Experience with utilization review, quality review, or clinical charting
• Strong clinical assessment and documentation review skills
• Excellent written and verbal communication skills

Ideal Candidate

This position is a strong fit for an RN who:

• Has acute care nursing experience and wants to transition into a clinical review role
• Has experience in utilization review, quality review, case review, or chart review
• Is comfortable reviewing medical records and clinical documentation
• Can work independently in an office-based environment
• Communicates professionally with clinical and administrative teams
• Has strong attention to detail and enjoys analytical nursing work